The rectouterine pouch (recto-uterine pouch), pouch of Douglas, or rectovaginal pouch is the extension of the

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mes ...

between the

rectum The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the sigmoid colon) at the l ...

and the posterior wall of the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...

in the human female. Its anterior boundary is formed by the posterior fornix of the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

Structure

In women, the rectouterine pouch is the deepest point of the peritoneal cavity. It lies posterior to the uterus and anterior to the rectum. (The pouch on the other side of the uterus is the vesicouterine pouch.) It is near the posterior

fornix of the vagina The fornices of the vagina (sing. fornix of the vagina or fornix vaginae) are the superior portions of the vagina, extending into the recesses created by the vaginal portion of cervix. The word "fornix" is Latin for "arch". Structure There are ...

. It is normal to have approximately 1 to 3 ml (or mL) of fluid in the rectouterine pouch throughout the

menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs ...

. After ovulation there is between 4 and 5 ml of fluid in the rectouterine pouch. In men, the region corresponding to the rectouterine pouch is the rectovesical pouch, which lies between the

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine ente ...

and rectum.

Clinical significance

The rectouterine pouch, being the lowest part of the peritoneal cavity in a woman at supine position, is a common site for the spread of pathology such as

ascites Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, a ...

tumour A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, fa ...

, pus, etc. As it is the furthest point of the abdominopelvic cavity in women, it is a site where infection and fluids typically collect. The rectouterine pouch can be used in the treatment of end-stage

kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...

in patients who are treated by

peritoneal dialysis Peritoneal dialysis (PD) is a type of dialysis which uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte pro ...

. The tip of the

dialysis catheter A dialysis catheter is a catheter used for exchanging blood to and from a hemodialysis machine and a patient. The dialysis catheter contains two lumens: venous and arterial. Although both lumens are in the vein, the "arterial" lumen, like natur ...

is placed into the deepest point of the pouch.

Culdocentesis

Culdocentesis Culdocentesis is a medical procedure involving the extraction of fluid from the pouch of Douglas (a rectouterine pouch posterior to the vagina) through a needle. It can be one diagnostic technique used in identifying pelvic inflammatory disease (i ...

is a procedure that draws fluid from the pouch, by way of the vagina using a needle. Fluid drawn using a scalpel incision is called a

colpotomy Culdocentesis is a medical procedure involving the extraction of fluid from the pouch of Douglas (a rectouterine pouch posterior to the vagina) through a needle. It can be one diagnostic technique used in identifying pelvic inflammatory disease ( ...

Naming and etymology

The rectouterine (or recto-uterine) pouch is also called the rectouterine excavation, uterorectal pouch, rectovaginal pouch, pouch of Douglas (after anatomist James Douglas, 1675–1742), Douglas pouch, Douglas cavity, Douglas space, Douglas cul-de-sac, Ehrhardt–Cole recess, Ehrhardt–Cole cul-de-sac, cavum Douglasi, or excavatio rectouterina. The combining forms reflect the rectum ('' recto-'', ''-rectal'') and uterus ('' utero-'', ''-uterine''). In

Obstetrics and gynaecology Obstetrics and Gynaecology (also spelled as Obstetrics and Gynecology; abbreviated as Obs and Gynae, O&G, OB-GYN and OB/GYN) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and t ...

, it is commonly referred to as the pouch of Douglas or the posterior cul-de-sac. The Douglas fold (rectouterine plica),

Douglas line The arcuate line of rectus sheath, the , the arcuate line, or the semicircular line of Douglas, is a horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath. It is commonly known simply as the arcuate line. It ...

, and Douglas septum are likewise named after the same James Douglas.

In popular culture

The Pouch of Douglas was featured in the

Netflix Netflix, Inc. is an American subscription video on-demand over-the-top streaming service and production company based in Los Gatos, California. Founded in 1997 by Reed Hastings and Marc Randolph in Scotts Valley, California, it offers a ...

special '' Hannah Gadsby: Douglas'' to deconstruct patriarchy.Hannah Gadsby: Douglas review
''Rolling Stone'' In Ghost World the Trivia Question at the Cafe where Scarlett Johansson's character works is "where in the human body is the Douglas Pouch located?"

Additional images

File:Gray1035.png, The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue). File:Illu female pelvis.jpg, Illu female pelvis

References

External links

* - "The Female Pelvis: Distribution of the Peritoneum in the Female Pelvis" * * * * * * {{Authority control Pelvis